Decreased Odds of Injection Risk Behavior Associated With Direct Versus Indirect Use of Syringe Exchange: Evidence From Two California Cities.
Decreased Odds of Injection Risk Behavior Associated With Direct Versus Indirect Use of Syringe Exchange: Evidence From Two California Cities.
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DOI：
10.1080/10826084.2017.1299182
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发表时间：
2017-07-29
影响因子：
2
通讯作者：
Gibson DR
中科院分区：
文献类型：
--
作者：
Behrends CN;Li CS;Gibson DR
背景：虽然有大量证据表明注射器交换计划（SEP）在注射吸毒者（PWID）中预防艾滋病毒感染方面是有效的，但几乎所有证据都来自直接从SEP获得注射器的PWID。对于间接从朋友或熟人那里获得注射器的PWID来说，二次交换的好处知之甚少。目的：我们在萨克拉门托和圣何塞进行了两项独立的研究，评估了直接与间接注射器交换在减少PWID中hiv相关高危注射行为方面的有效性，这两个城市的注射器交换模式截然不同。方法：在这两项研究中，采用多变量logistic回归模型检验直接和间接注射器交换与自我报告的危险行为之间的关系。研究1评估了萨克拉门托“卫星”家庭注射器交换的效果，而研究2评估了圣何塞传统的固定地点交换。结果：多变量分析显示，萨克拉门托和圣何塞直接使用SEP的高危注射分别减少了95%和69%，萨克拉门托间接使用SEP的高危注射减少了46%。结论/重要性：萨克拉门托直接使用SEP的效果非常大，部分原因可能是由于无菌注射器的家庭交付。虽然间接使用的效果较为温和，但这种使用对于降低无法或不愿前往注射器交换处的PWID患者的艾滋病毒传播风险是有价值的。
Background: While there is substantial evidence that syringe exchange programs (SEPs) are effective in preventing HIV among people who inject drugs (PWID), nearly all the evidence comes from PWID who obtain syringes from an SEP directly. Much less is known about the benefits of secondary exchange to PWID who get syringes indirectly from friends or acquaintances who visit an SEP for them.Objectives: We evaluated the effectiveness of direct versus indirect syringe exchange in reducing HIV-related high-risk injecting behavior among PWID in two separate studies conducted in Sacramento and San Jose, California, cities with quite different syringe exchange models.Methods: In both studies associations between direct and indirect syringe exchange and self-reported risk behavior were examined with multivariable logistic regression models. Study 1 assessed effects of a “satellite” home-delivery syringe exchange in Sacramento, while Study 2 evaluated a conventional fixed-site exchange in San Jose.Results: Multivariable analyses revealed 95% and 69% reductions, respectively, in high-risk injection associated with direct use of the SEPs in Sacramento and San Jose, and a 46% reduction associated with indirect use of the SEP in Sacramento.Conclusions/Importance: The very large effect of direct SEP use in Sacramento was likely due in part to home delivery of sterile syringes. While more modest effects were associated with indirect use, such use nevertheless is valuable in reducing the risk of HIV transmission of PWID who are unable or unwilling to visit a syringe exchange.
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